This is a tumor board of approximately 40 radiologists, oncologists, pathologists, surgeons and genetic counselors who review a list of breast cancer patients and recommend a course of treatment.

“It’s usually between eight and 14 patients presented every Monday, just for breast,” said Dr. Brian Leyland-Jones, who became director of Edith Sanford Breast Cancer Research one year ago.

Sometimes, the answers are relatively automatic. Patients are offered conventional care or participation in a clinical trial. There’s usually a sequence of options. Drugs are tested.

“But after the first rounds, it’s like dealer’s choice which one you try next,” Leyland-Jones said. “Each of them literally has a 15 percent chance of having a response rate.”

Sitting on the tumor board when those scenarios arrive on the agenda is frustrating, to say the least, he said.

“The patient will turn around and say: ‘I will take anything. I will do anything to give me a chance of having a personalized therapy.’ ”

The Edith Sanford breast cancer initiative is designed to deliver that chance. Launched in 2011 with a $100 million donation from T. Denny Sanford, its goal is to unlock each patient’s genetic code to prevent, treat and ultimately cure breast cancer.

“This is absolutely game-changing,” Leyland-Jones said. “It will give you clues of what to treat next.”

More than two years later, there are clear signs of progress.

Sanford recently performed genetic sequencing on its first breast cancer patient. The individual had tried multiple drugs unsuccessfully, but the genetic profile suggested other drugs might be more effective. So far, it shows the promise of using sequencing to help determine treatment, Leyland-Jones said.

“I sent an email (checking on the patient) to the physician at 11 p.m. last night,” he said, when asked how closely he’s watching the case.

Risk assessment changes

In the new world of genomic medicine, such personalized care will start before cancer strikes, Leyland-Jones said.

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Part of the Edith Sanford program involves changing how all women are assessed for breast cancer risk.

“Your risk as an individual is different just as treatment is individual,” Leyland-Jones said.

The first tool being developed is a 15- to 20-minute self-assessment, which any patient can complete at a physician’s office or at home on a computer. It will ask about family history and lifestyle factors.

It will be implemented in the near future, according to Sharon Hunt, vice president at Sanford Clinic.

Sanford also is working with a group in Sweden to calibrate digital mammography machines that can produce more specific breast density measurements.

“Everyone realizes breast density is incredibly important” in risk assessment, Leyland-Jones said. “But the software is just coming about now.”

The program might be available at Sanford in the next six months.

“That could allow us to do research and correlate that more specific measurement of density with a woman’s risk,” Hunt said.

The final piece of risk assessment will be a blood test to extract DNA.

“There are around 80 genes identified at this moment that put you at risk,” Leyland-Jones said. “So we’ll use a compilation of the density, the survey and the genomics, combine those three to individualize your risk.”

From there, patients’ frequency of mammography and intensity of follow-up will be determined.

“You feel like you have some power now to prevent this disease,” Hunt said. “It makes you feel like we’re helping to win this war.”

Clinical trials begin

Sanford’s research is done in concert with organizations in a handful of other states. Several new clinical trials have been brought in, and Sanford will lead a multi-institutional trial in forward genomics in the coming weeks.

Patients with metastatic breast cancer who have no immediate matching therapy are eligible to participate.

“We’re hoping at least half the patients will be Sanford’s,” Leyland-Jones said.

The Sanford team will use what Leyland-Jones calls the best specialists in the world to conduct facets of the trial, including researchers at Scripps Research Institute.

“We’re generating terabytes of data in a week when we run most of these experiments, and a decade ago most people didn’t even know how many zeroes that is,” he said. “You have this immediacy of knowing I’m really affecting someone’s life and a family’s life. Traditionally, you look at academic research, it takes awhile and we don’t have that luxury.”

Young will send the data gathered to California, where colleague Nicholas Schork and his team will analyze it.

“What my group tries to do is separate the wheat from the chaff, the stuff that all human cells have versus what’s in the cancer cells uniquely,” Schork said. “We’re trying to identify things that are causing the tumor to grow that would indicate ways of combating that.”

The genetic analysis, including drugs that might be a good fit, will be sent to the patient’s tumor board, where it will become one more tool the board can use to recommend treatment.

“No one is trying to pursue this in a way that would treat these patients as guinea pigs,” Schork said. “Genomic profiling is not going to dictate therapy. It’s going to add to the therapy.”

It’s also going to happen fast. The whole process is scheduled to take no longer than three weeks.

“The people who have metastatic breast cancer don’t have a lot of time for us to screw around. That’s one of the controversial but also cutting-edge things about this trial,” Schork said. “This is all about bringing sophisticated molecular biology to bear in treatment decision-making that has to be done in real time.”

An initial group of 25 patients will have their tumors genetically sequenced with another group of 100 to 150 to follow.

Major fundraising goal

While $100 million kick-started the Edith Sanford initiative, maintaining the momentum will take more.

Leading the fundraising effort is Kimberly Simpson, president of the Edith Sanford Breast Cancer Foundation and a former top executive at Susan G. Komen for the Cure and Mothers Against Drunk Driving.

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“I really felt the same feeling I had when I worked in Silicon Valley during the go-go days of high technology,” Simpson said. “It was the sky’s the limit, and if you’re smart you can do it, and we’re going to dream up these things, and we’re going to make them happen.”

Simpson has a staff of 20 and a downtown office in the CNA Surety building. She said the foundation has spent the past year building an infrastructure to raise awareness of the effort nationally.

The ultimate goal is to reach $100 million in annual donations.

“We look at that as our aspirational goal,” Simpson said. “It’s one I think we can reach.”

In its first year, the foundation gained support from 50,000 donors nationwide.

It recently started a direct-response television campaign, piloting the spot in certain markets. It features national spokeswoman Mary Hart, along with breast cancer patients and survivors.

“We’re using television as a vehicle to raise money,” Simpson said. “That hasn’t really been done in breast cancer, so we felt there was a real opportunity there to share our message and reach out all over the country.”

The Edith Sanford message stands out from other efforts to raise money for breast cancer because of its unique value proposition, Simpson said. Because of Sanford’s initial contribution, 100 percent of other donations go directly into research instead of also having to cover the administrative costs of fundraising.

A nationwide survey done by the foundation also revealed that the top thing donors seek in a breast cancer organization is research into the cure, she said.

“We’re the only national breast cancer organization that is actually doing the research,” Simpson said. “Not that there aren’t other organizations that support research, but that’s all we do. And that resonates with people.”

Some prospective donors are brought to Sioux Falls to observe the work, she said.

“Because when you come here and you feel the energy and passion for what we’re doing … it’s just wow,” Simpson said.

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The local affiliate of Susan G. Komen for the Cure also has ties to Sanford, which is a sponsor of the organization’s annual race. Executive director Mary Kolsrud said 75 percent of the money Komen raises stays in the state for services such as mammography and patient assistance, and 25 percent goes to the national organization for research.

“They (Edith Sanford fundraisers) are targeting more nationally, so that will help them,” Kolsrud said. “At the end of the day, the more researchers who are working on that … I think benefits everyone.”

At Edith Sanford, a photograph of the program’s namesake overlooks the office. Simpson said the mother T. Denny Sanford lost at childhood serves as a daily reminder of the goal at hand.

Back in the lab, Leyland-Jones looks back at a year’s work and said everything he promised Sanford was delivered on time.

“We do live in the age of genomic medicine now,” he said. “It will be transformative. And this is not just genomic oncology. The whole of medicine will be practiced in this way.”